RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01337
BRANCH OF SERVICE:  Navy 	SEPARATION DATE:  20020331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E3, Dental Technician, medically separated for “cervical strain” and “lumbar strain,” rated 10% and 10%, respectively, with a combined disability rating of 20%.

CI CONTENTION:  “Review all conditions.”  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20020109	VARD - 20020409	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Cervical Strain	5299-5295	10%	Residuals, Cervical Spine Strain	5299-5290	10%	20020128	
Lumbar Strain	5295	10%	Residuals, Lumbar Spine Strain…	5299-5293	20%		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Cervical Strain.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s neck condition began in February 2001 following a motor vehicle accident (MVA).  The MEB forwarded cervical strain for PEB adjudication.  The MEB NARSUM examination on 24 August 2001, 7 months prior to separation, noted complaints of neck pain.  Physical examination showed no cervical spinous process tenderness.  Range of motion (ROM) was normal but limited by pain and annotated as approximately “80 degrees to right and left”; extension and flexion were “limited due to spasticity” as reported by the CI.  There was mild tenderness but no muscle spasms.  There were no neurological or strength deficits observed in the upper extremities nor was any muscle atrophy visualized.  A magnetic resonance imaging (MRI) study of the cervical spine showed no disc bulge or compression of the nerve roots of the spinal cord.  At the 28 January 2002 VA Compensation and Pension (C&P) evaluation, 2 months before separation, the CI reported pain in his neck.  Physical examination showed the right-hand dominant CI was able to make a tight fist bilaterally and hand strength was normal.  The finger ROM was annotated as normal.  Examination of the cervical spine showed evidence of painful motion, muscle spasm, weakness and tenderness.  Cervical ROM flexion and extension were normal at 45 degrees and 30 degrees respectively, right and left  lateral flexion were 30 degrees (normal 45), right rotation 60 degrees (normal 80) and left rotation 70 degrees.  The examiner noted that the ROM of the affected joint was initially limited “by pain, fatigue, weakness, and lack of endurance or incoordination.”  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the neck condition 10%, coded 5299-5295 (analogous to lumbosacral strain).  The VA also rated the neck condition 10% coded 5299-5290 (analogous to limitation of motion of the cervical spine), based on the C&P examination 2 months before separation, citing slightly limited cervical spine motion.  There was no evidence of moderate limitation of motion of the cervical spine or loss of lateral rotation for a 20% rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the cervical strain condition.  

Lumbar Strain.  The back pain was secondary to the MVA as mentioned above.  The MEB forwarded lumbar strain for PEB adjudication.  At a physical therapy appointment on 06 April 2001, 12 months prior to separation, the CI continued to use a cane for ambulation, was observed to walk with an antalgic gait and complained of pain with flexion of the back, and headache “just about every day.”  The lumbar active ROM was annotated as flexion to proximal tibia, extension 50%, and rotation and side-bending were both 75%.  The CI was observed to hip flex to 130 degrees bilaterally with mild lower back pain; squat to 45 degrees with a straight back symmetrically; march in place with hip flexed at greater than or equal to 90 degrees; and he was able to stand steady on one leg with minimal lower back pain.  At a physical therapy appointment on 24 May 2001, 10 months prior to separation, the CI complained of burning, throbbing sensations going down both legs. The CI stated that he used his cane intermittently.  Physical examination of the lumbar spine found active ROM demonstrated flexion to the knees, extension 25 percent and full symmetric side-bending.  There was tenderness at the lumbar midline and para-spinal musculature.  

At a neurosurgery follow-up appointment on 23 July 2001, 9 months prior to separation, the CI complained of pain in his low back and neck, and headaches. The CI was not taking any medications.  Lumbar ROM was noted as flexion to 45 degrees (normal 90), extension 10 degrees (normal 30) and lateral flexion to 30 degrees (normal) bilaterally.  There was mild tenderness to the area without any muscle spasms palpated by the examiner.  The MEB NARSUM examination on 24 August 2001, 7 months prior to separation, noted complaints of worsening low back pain with radiation to the leg associated with physical therapy exercising and continual use.  The CI reported he stopped using the cane in May 2001.  Physical examination showed intermittent para-lumbosacral muscle spasms and diffuse chronic tenderness of the myofascial tissue of the back.  Lumbar ROM was limited in flexion and extension due to intermittent worsening of the palpable spasmodic para-lumbar musculature and reported discomfort to the area.  The examiner noted no muscle atrophy or neurological or strength deficits in the lower extremities.  MRI of the lumbosacral spine showed mild broad-base posterior disk bulges at L3/L4 without compromise of the nerve root, spinal canal, anterior recesses or neural foramina.  However, the examiner also noted an L5 to S1 mild broad-base posterior disc bulge causing mild central canal and anterior recess stenosis.  At the 28 January 2002 VA C&P evaluation, 2 months before separation, the CI reported that he had constant pain associated with weakness, lack of endurance, stiffness, and instability with ambulation.  The CI stated that any type of activity could cause the pain to “flare” without alleviation.  He admitted taking Piroxicam daily and using a cane with ambulation.  The CI worked as a dental assistant and had difficulty most days completing a workday due to back pain.  Physical examination presented with abnormal posture with exaggerated kyphosis of the thoracic spine, and an antalgic gait with the use of a cane.  Without the use of a cane, the CI walked with a limp and stood with unequal pressure distributed on the feet due to adjusting for the back pain.  The lumbar spine demonstrated painful motion, muscle spasms and tenderness to the para-spinal musculature.  ROM was measured at flexion 20 degrees (normal 95), extension 5 degrees (normal 35), right and left lateral side-bending 10 degrees (normal 40), right rotation 10 degrees (normal 35), left rotation 10 degrees (normal 35) with association of pain at the end of all ROM.  The examiner noted that the ROM was not additionally limited by fatigue, weakness, lack of endurance, or incoordination.  

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the low back condition 10%, coded 5295 (lumbosacral strain).  The VA rated the lumbar condition 20%, coded 5299-5293 (analogous to intervertebral disc syndrome [IVDS]), based on the C&P examination 2 months before separation, citing recurring attacks of moderate IVDS.  Although there was evidence of intermittent lumbosacral muscle spasms, the spasms were not associated with extreme forward bending or loss of lateral spine motion in the standing position for a rating of 20%.  The evidence did not support IVDS resulting in moderate recurring attacks to warrant consideration of rating under the alternate VASRD formula for that condition.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the lumbar strain condition.  

BOARD FINDINGS:  In the matter of the cervical strain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  In the matter of the lumbar strain condition and IAW VASRD §4.71a, the Board majority recommends no change in the PEB adjudication.  The single voter for dissent recommended modification to 20% and did not elect to submit a minority opinion.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150616, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
               BOARDS 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATIONS
 
Ref:   (a) DoDI 6040.44
       (b) CORB ltr dtd 25 Apr 17

      In accordance with reference (a), I have reviewed the cases forwarded by reference (b), and, for the reasons provided in their forwarding memorandums, approve the recommendations of the PDBR that the following individual’s records not be corrected to reflect a change in either characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board:

		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USN 
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USN
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC
		- XXXXXXXXXXXXXXXXXX, former USMC